This is the birth story of my second child born Feb. 2, 2010 at Twin Cities Hospital.
I loved being pregnant; (almost) everything about it. I had rather easy pregnancies compared to some that I've heard of before. I thank the Lord for that! Never got sick, although I did have some complications early on in this pregnancy and was advised to quit my housekeeping jobs. I was just over doing it. Had horrible pains one night, cramping, and some very heavy bleeding. I went into panic mode, expecting the worst. Spoke with the Dr. on call, went in for an emergency ultrasound early the next morning and discovered that everything was fine. Again, Thank you Lord!
Months later, we passed the due date of Jan 26th, patiently waiting for that moment. I was having contractions for about 2-3 weeks here and there, having a lot of "not sure if this is it moments" then finally, decided, since my Dr. suggested it, to have my membranes stripped. Not as painful as I thought it would be. Then that night, odd, right at 12:00AM , I woke up from just dozing off it seemed, to a light "pop" sound. Now, my water never broke with my first, they had to break it for me, so this was new to me. Even after hearing that, I just still wasn't sure if "this was it". I raised up in bed, stepped out of bed and felt a slight wetness, but again, I wasn't sure because this little guy had been SUPER low for a while now and I was loosing bladder control a lot, so I first thought, maybe he's putting enough pressure on me down there that I just trickled and didn't make it to the bathroom to pee.
Shortly after that though, I began having contractions and again, I still was not yet convinced that "this was it". My husband woke because he heard me pacing and breathing. I remember telling him, I'm just not sure if this is it or not, I'm not sure if you need to get out of bed yet. However, the contractions were coming a lot harder, painful, and more regular, & rather quickly. I finally told myself, ok, if this isn't it, I'm going to be upset because this hurts! I told my husband that I thought my water broke, but I wasn't sure. I was still trickling though, staying sort of wet.
Hubby decided to get up, saying that "well, we need to go to the hospital but let me brew a pot of coffee first". LOL. Taking our time, all the while they were getting more painful, I finally knew, this is it! I live about 10 minutes from Twin Cities Community Hospital. Thank goodness! We arrived at the hospital at 12:55AM. My pants were definitely wet at this point.
Now I had preregistered, but what the point of that was I have no idea. I get in there, they put me in the triage room, check me, I was 4cm dilated. They said, we'll get you checked in. I said, ok, I do want an epidural this time around. They said ok. He lives just around the corner and we'll get him here when we get you all checked in. Ok great. I was really looking forward to that this time. Things just don't always go as planned, not even for the nurses!
I was hurting, badly, feeling the urge to push like crazy. Telling them, I need it now, come on with it! I remember looking at this nurse, saying, I'm really not a mean person okay! They all still kept taking their time, getting me checked in, etc. Not sure what the hold up was. I just knew it was time to push. I was ready, breathing hard, trying to get through each contraction which at this point was back to back, barely a break at all. I was beginning to think they didn't know what they were doing and that maybe I should of been doing this on my own, because really, I was. My husband just stared at me telling me no, don't push yet.
Finally, still not checked in, another nurse comes to check and see how far I am, keep in mind, only about 15-20 mins had gone by since I got there. I was at 8cm. and there was blood, I was ready. Suddenly I saw the panic in their faces a bit, scurrying around, rushing a bit more now, saying get the Dr. it's time. I asked for an epidural yet again, they said, "oh honey, it's to late for that." I was mad because I was trying to tell them, I needed to push, why don't they listen!?! I'm still in the triage room when the Dr. comes in no scrubs or nothing, saying she hopes for nothing to get on her shoes. I remember thinking, woman, I don't care about your shoes! My husband refers to the bed as a "transformer bed" as quickly as they got this thing ready for what was about to happen!
I was so worried about tearing because I did with my first and that is what I remember most about my first delivery because when I went to pee afterwards, the best way to describe it was like "peeing razor blades", I did not want that to happen again! That is what I was terrified most of! But, one big long push, (and feeling some poop come out as well, eww, embarrassing, but I knew the doctor had seen it before), there he was! It was 1:38AM, I had arrived at the hospital at 5 minutes to 1:00 and he was born at 1:38. Even they were shocked and surprised at how quickly he came. And I didn't tear! YEAH!
7pounds 8ounces. 20in long. Baby Boy Landon. Feb 2, 2010.
(Jennifer-one hour 38 minutes from start to finish! What a mad rush this birth must have been. These fast births take every one's breath away. Often the hospital staff is caught off guard because they have many first time moms come in thinking they are far into labor when they aren't. I never doubt a second time birther. If they say the baby is coming or they have to push you better believe them! I don't know why the OB staff still disbelieves the mom until they prove it to themselves via a vaginal check.)
Now during the stay at the hospital, they informed me that they were going to do a drug test on me and the baby because of how quickly he was born. They said they had seen it where people place bets on when the baby is going to be born and so they'll win, they drug induce labor. I was shocked, blown away at what I had just heard. Wow.
A while later, I did get the medical bill and I called and got an itemized detail of the charges of my stay, on that list was about 8 lab tests they had done for testing for 8 different drugs. Each one costing $200-$500. I think it was about $2800+ worth of tests. Crazy! I called and disputed it, saying, you didn't ask me for these tests, you took it upon yourself and said that it's hospital protocol that you do it, so I don't feel like I should have to pay for this (we did have insurance, but still). They, without question, took all 8 off of the bill. Very interesting I thought.
(Jennifer-I have never heard of this before.)
So, you'd think as fast as that was, my birth story would be shorter. LOL. But here I am, blessed with 2 beautiful boys! Both naturally. Even though I had planned on having an epidural the second time around, it just didn't happen that way. Someone else had a different plan and I just took a deep breath and said ok, here we go. I CAN DO THIS! That was that! Now my husband and I are all done. Two kids is enough for us. Especially 2 boys with my husbands blood running through them! LOL.
Jackie
(I e-mailed Jackie to ask her how far past her due date she was when the doctor first suggested she have her membranes stripped.)
Jackie wrote:
"Let's see, I was 1 week past. My Doctor had actually mentioned it to me before. I was 3 cm dilated for a couple of weeks. After he was born, the nurse said, I was even further along than the due date they had given me as well. "
(Goodness a good doula would know that any second time mom who has been hanging out at 3 centimeters for a couple of weeks and then goes into strong back to back contractions is going to move very quickly! As to due dates, don't even get me started. They are notorious for being off regardless of ultrasound technology. After babies are born the nurse does an assessment to try to guesstimate how developed your baby is, which helps them know how many weeks gestation actually occurred before the baby was born.)
Thursday, August 12, 2010
Thursday, July 22, 2010
New Guidelines Aim to Reduce Repeated C-Sections
Great reporting on an important birth issue by someone in the mainstream media! This reporter does an excellent job of thoroughly explaining the complexities of the issues surrounding giving women back the right to make their own choice to try for a vaginal birth after a previous cesarean or to go with a repeat surgical birth.
But before you read it let's put it into historical, local, political, and a doula's context.
When I was in my twenties the cesarean rate was rising. Like my sister-in-law most of these women were being sectioned the first time for something called cephalopelvic disproportion. This means the baby's head (cephalo) is too big (disproportion) to fit through mom's passageway (pelvic). How did they figure this out? Two ways. One was a labor that wasn't progressing at the rate of speed the medical community agreed was normal at that time. I say "at that time" because I have worked with plenty of local doctors who no longer practice with this older time frame model in mind. Or before she ever began labor they might xray the mom , take measurements and make a determination without even a trial of labor. Of course this practice has now been abandoned. Xraying moms; it sounds crazy doesn't it? Guess what! We still routinely ultrasound moms who have gone past their due date and one of the things the doctor does is make a recommendation to your OB or midwife about the possible size of your baby and whether you should be sectioned for...wait for it...here it comes...cephalopelvic disproportion or possible shoulder dystocia (shoulders to big to fit) before you even try!
The second reason women were being operated on to give birth was the fact that they had been operated on to give birth. This was the era of "once a cesarean, always a cesarean". The surgical technique of the time was to cut the mom vertically from below the ribs to the pubic bone. This classical cut was associated with a high rate of rupture during future labors. The ghost of this fear based on the rupture rate of classical incisions is still with us today in the doctor's office when women discuss their "options" for future births. It is still in women's hearts too, passed down to them from their mother's birth era.
When I was in my thirties things were changing. The medical community had realized the cesarean rate was sky rocketing and they needed to do something about it. Surgical technique for incisions and suturing had changed; the "bikini cut" had come into vogue, and the risk of rupture had been significantly reduced. Also consumers had put pressure on the medical establishment by taking matters into their own hands; either birthing out of hospitals all together to achieve their V-BAC, or going into the hospital late in labor and refusing to undergo a repeat surgery. Doulas were being asked to labor sit at home with these moms and try to bring them to the hospital at the last moment. These brave pioneers proved women could safely and successfully labor and birth vaginally after a previous surgical birth. They proved V-BAC was a viable option for many women. I remember Dr. Clutter and Dr. Lickness being our first local doctors to support women in this choice.
When I was in my late thirties it was the norm to at least go through a "trial of labor" before deciding to section a woman again. Some of our doctors were much more liberal in their "trials" than other local doctors. As a doula I often felt I had to match wits with some of our more scalpel ready doctors to keep my clients out of the operating room. Another positive change was our local certified nurse midwives being allowed by their supervising doctors to V-BAC women in all our hospitals. Sandy Rodriguez and JoAnne Tarkington caught many, many a successful V-BAC baby.
By my forties the pendulum was swinging back. The fear of uterine rupture was again haunting doctors' offices and labor rooms. A study came out showing that V-BAC women had a greater chance of rupturing than nonV-BAC women. This study lumped all women together without taking into account if the mom went into labor on her own or if she was induced. It also didn't make any distinction as to the method used for induction. (Remember that wonderful induction drug Cytotec? This is the era it is becoming more popular among the medical community. Don't know about Cytotec? Read my piece, Let's Talk about Off Label Use, Cytotec and You.) In reponse to the study the American College of Obstetricians and Gynecologists (ACOG) came out with guidelines requiring hospitals to have anesthesiologists waiting in the hospital the entire time a V-BAC mom labored. Most hospitals found this a financial, practical, legal and bureaucratic impossibility. For a brief time all V-BACs were shut down at our hospitals. Luckily for us Sierra Vista took the bold step of contracting with our local anesthesiologists for enough coverage to allow Sierra Vista to offer the V-BAC option to women in our community. But it is the only hospital within hundreds of miles to do so! I recently had a client who moved back from Santa Barbara to Atascadero just so she could successfully V-BAC at Sierra. ACOGs guidelines also required OBs to be standing by throughout potentially long labors. For many doctors' practices this was a practical, geographic, and financial impossibility. So if your OB's office was located physically close enough to Sierra Vista you could V-BAC, if not you could not. And of course our wonderful nurse midwives were no longer "skilled" enough to catch V-BAC babies. I will never forget the last V-BAC I was at with Sandy and JoAnn. My client had been told she could V-BAC with them but when she was in labor in the hospital she was told the supervising doctors could no longer advise she go for a vaginal birth because she was past her due date. My client decided to refuse to say yes to another surgery. Sandy supported her decision and JoAnn did a great job catching a beautiful healthy baby girl. I have never been more proud of three women in my life. Meanwhile women continue to safely V-BAC with our licensed midwives at home and with doctors at Sierra Vista every day.
When I was fifty I was hired as a doula by a woman who was trying to find some way to not end up with a second operative birth. She was caught in a terrible bind. Her due date fell at a time when one of our homebirth midwives was not practicing and the other was already over committed trying to service all the local women who wanted to birth at home. Her MediCal doctor had deemed her too great a risk for V-BAC and wanted her to have a repeat operation. He put her under extreme pressure to agree to a surgical birth, even sending her a certified letter saying he had explained the risks to her of not agreeing to a surgical birth and requiring her to get a notarized signature. Although the nurse midwives wer supportive of her desire they could not help her. It was suggested to her that she labor at home with me for as long as possible, then come to the hospital and refuse the surgery. You tell me how it can possibly be a good choice to labor at home without a skilled medical attendant, with a woman who has more risk of things going wrong, without anyone who can take the baby's heart tones or has any emergency equipment or training? This is an impossible position to put doulas in. My client called me late into her labor and when I arrived at her home it was quickly obvious to me she would be pushing soon. I told her we needed to go to the hospital and she begged me to stay with her at home and catch her baby. She told me she trusted me. I told her I couldn't do it, I had no equipment and no experience. I convinced her to go to the hospital and she ended up with another c-section. An outcome that will weigh on both our hearts forever.
In the last few months I have seen another change on the horizon. I believe we are witnessing a new V-BAC era being born. There have been a flurry of studies, articles and announcements about the concern over the rise in our national cesarean rate, balancing risks of repeat c-sections versus v-bac and a woman's right to choose. The National Institute of Health came out with their finding which has pushed ACOG to review it's guidelines and make their own announcement. Read Neergaard's great article to see where we are headed.
By LAURAN NEERGAARD
AP Medical Writer
Most women who've had a C-section, and many who've had two, should be allowed to try labor with their next baby, say new guidelines - a step toward reversing the "once a cesarean, always a cesarean" policies taking root in many hospitals.
Wednesday's announcement by the American College of Obstetricians and Gynecologists eases restrictions on who might avoid a repeat C-section, rewriting an old policy that critics have said is partly to blame for many pregnant women being denied the chance.
Fifteen years ago, nearly 3 in 10 women who'd had a prior C-section gave birth vaginally the next time. Today, fewer than 1 in 10 do.
Last spring, a National Institutes of Health panel strongly urged steps to reverse that trend, saying a third of hospitals and half of doctors ban women from attempting what's called VBAC, for "vaginal birth after cesarean."
The new guidelines declare VBAC a safe and appropriate option for most women - now including those carrying twins or who've had two C-sections - and urge that they be given an unbiased look at the pros and cons so they can decide whether to try.
Women's choice is "what we want to come through loud and clear," said Dr. William Grobman of Northwestern University, co-author of the guidelines. "There are few times where there is an absolute wrong or an absolute right, but there is the importance of shared decision-making."
Overall, nearly a third of U.S. births are by cesarean, an all-time high. Cesareans can be lifesaving but they come with certain risks - and the more C-sections a woman has, the greater the risk in a next pregnancy of problems, some of them life-threatening, like placenta abnormalities or hemorrhage.
The main debate with VBAC: That the rigors of labor could cause the scar from the earlier surgery to rupture. There's less than a 1 percent chance of that happening, the ACOG guidelines say. Also, with most recently performed C-sections, that scar is located on a lower part of the uterus that's less stressed by contractions.
Of those who attempt VBAC, between 60 percent and 80 percent will deliver vaginally, the guidelines note. The rest will need a C-section after all, because of stalled labor or other factors. Success if more likely in women who go into labor naturally - although induction doesn't rule out an attempt - and less likely in women who are obese or are carrying large babies, they say.
Thus the balancing act that women and their doctors weigh: A successful VBAC is safer than a planned repeat C-section, especially for women who want additional children - but an emergency C-section can be riskier than a planned one.
Because of those rare uterine ruptures, the obstetricians' group has long recommended that only hospitals equipped for immediate emergency C-sections attempt VBACs. Many smaller or rural hospitals can't do that, and that recommendation plus high-dollar lawsuits have been blamed for some hospital VBAC bans.
"Restricting access was not the intention," the new guidelines say. They say hospitals ill-equipped for immediate surgery should help women find care elsewhere, have a plan to manage uterine ruptures anyway, and not coerce a woman into a repeat C-section.
Educating women about their options early enough in pregnancy for them to make an informed choice is key, said Dr. F. Gary Cunningham of the University of Texas Southwestern Medical Center, who chaired the NIH panel on repeat C-sections.
It requires a fair portrayal of risks and benefits that can differ by patient, added Dr. Howard Minkoff of Maimonides Medical Center in Brooklyn, N.Y., which has women sign a special VBAC consent after counseling yet has a higher-than-average VBAC rate of 30 percent.
"There's no doubt that how things get framed influences how people act," he said.
While the guidelines cannot force hospital policy changes, some women's groups welcomed them.
"I feel like ACOG has really listened to how their previous policies have impacted women," said Barbara Stratton of the International Cesarean Awareness Network's Baltimore chapter, adding that she'll advise women seeking a VBAC to hand a copy of the guidelines to caregivers who balk.
But she called for reducing overuse of first-time C-sections, too, so that repeats become less of an issue.
Read more: http://www.sanluisobispo.com/2010/07/21/1223164/new-guidelines-aim-to-reduce-repeated.html#ixzz0uQm4tHXf
But before you read it let's put it into historical, local, political, and a doula's context.
When I was in my twenties the cesarean rate was rising. Like my sister-in-law most of these women were being sectioned the first time for something called cephalopelvic disproportion. This means the baby's head (cephalo) is too big (disproportion) to fit through mom's passageway (pelvic). How did they figure this out? Two ways. One was a labor that wasn't progressing at the rate of speed the medical community agreed was normal at that time. I say "at that time" because I have worked with plenty of local doctors who no longer practice with this older time frame model in mind. Or before she ever began labor they might xray the mom , take measurements and make a determination without even a trial of labor. Of course this practice has now been abandoned. Xraying moms; it sounds crazy doesn't it? Guess what! We still routinely ultrasound moms who have gone past their due date and one of the things the doctor does is make a recommendation to your OB or midwife about the possible size of your baby and whether you should be sectioned for...wait for it...here it comes...cephalopelvic disproportion or possible shoulder dystocia (shoulders to big to fit) before you even try!
The second reason women were being operated on to give birth was the fact that they had been operated on to give birth. This was the era of "once a cesarean, always a cesarean". The surgical technique of the time was to cut the mom vertically from below the ribs to the pubic bone. This classical cut was associated with a high rate of rupture during future labors. The ghost of this fear based on the rupture rate of classical incisions is still with us today in the doctor's office when women discuss their "options" for future births. It is still in women's hearts too, passed down to them from their mother's birth era.
When I was in my thirties things were changing. The medical community had realized the cesarean rate was sky rocketing and they needed to do something about it. Surgical technique for incisions and suturing had changed; the "bikini cut" had come into vogue, and the risk of rupture had been significantly reduced. Also consumers had put pressure on the medical establishment by taking matters into their own hands; either birthing out of hospitals all together to achieve their V-BAC, or going into the hospital late in labor and refusing to undergo a repeat surgery. Doulas were being asked to labor sit at home with these moms and try to bring them to the hospital at the last moment. These brave pioneers proved women could safely and successfully labor and birth vaginally after a previous surgical birth. They proved V-BAC was a viable option for many women. I remember Dr. Clutter and Dr. Lickness being our first local doctors to support women in this choice.
When I was in my late thirties it was the norm to at least go through a "trial of labor" before deciding to section a woman again. Some of our doctors were much more liberal in their "trials" than other local doctors. As a doula I often felt I had to match wits with some of our more scalpel ready doctors to keep my clients out of the operating room. Another positive change was our local certified nurse midwives being allowed by their supervising doctors to V-BAC women in all our hospitals. Sandy Rodriguez and JoAnne Tarkington caught many, many a successful V-BAC baby.
By my forties the pendulum was swinging back. The fear of uterine rupture was again haunting doctors' offices and labor rooms. A study came out showing that V-BAC women had a greater chance of rupturing than nonV-BAC women. This study lumped all women together without taking into account if the mom went into labor on her own or if she was induced. It also didn't make any distinction as to the method used for induction. (Remember that wonderful induction drug Cytotec? This is the era it is becoming more popular among the medical community. Don't know about Cytotec? Read my piece, Let's Talk about Off Label Use, Cytotec and You.) In reponse to the study the American College of Obstetricians and Gynecologists (ACOG) came out with guidelines requiring hospitals to have anesthesiologists waiting in the hospital the entire time a V-BAC mom labored. Most hospitals found this a financial, practical, legal and bureaucratic impossibility. For a brief time all V-BACs were shut down at our hospitals. Luckily for us Sierra Vista took the bold step of contracting with our local anesthesiologists for enough coverage to allow Sierra Vista to offer the V-BAC option to women in our community. But it is the only hospital within hundreds of miles to do so! I recently had a client who moved back from Santa Barbara to Atascadero just so she could successfully V-BAC at Sierra. ACOGs guidelines also required OBs to be standing by throughout potentially long labors. For many doctors' practices this was a practical, geographic, and financial impossibility. So if your OB's office was located physically close enough to Sierra Vista you could V-BAC, if not you could not. And of course our wonderful nurse midwives were no longer "skilled" enough to catch V-BAC babies. I will never forget the last V-BAC I was at with Sandy and JoAnn. My client had been told she could V-BAC with them but when she was in labor in the hospital she was told the supervising doctors could no longer advise she go for a vaginal birth because she was past her due date. My client decided to refuse to say yes to another surgery. Sandy supported her decision and JoAnn did a great job catching a beautiful healthy baby girl. I have never been more proud of three women in my life. Meanwhile women continue to safely V-BAC with our licensed midwives at home and with doctors at Sierra Vista every day.
When I was fifty I was hired as a doula by a woman who was trying to find some way to not end up with a second operative birth. She was caught in a terrible bind. Her due date fell at a time when one of our homebirth midwives was not practicing and the other was already over committed trying to service all the local women who wanted to birth at home. Her MediCal doctor had deemed her too great a risk for V-BAC and wanted her to have a repeat operation. He put her under extreme pressure to agree to a surgical birth, even sending her a certified letter saying he had explained the risks to her of not agreeing to a surgical birth and requiring her to get a notarized signature. Although the nurse midwives wer supportive of her desire they could not help her. It was suggested to her that she labor at home with me for as long as possible, then come to the hospital and refuse the surgery. You tell me how it can possibly be a good choice to labor at home without a skilled medical attendant, with a woman who has more risk of things going wrong, without anyone who can take the baby's heart tones or has any emergency equipment or training? This is an impossible position to put doulas in. My client called me late into her labor and when I arrived at her home it was quickly obvious to me she would be pushing soon. I told her we needed to go to the hospital and she begged me to stay with her at home and catch her baby. She told me she trusted me. I told her I couldn't do it, I had no equipment and no experience. I convinced her to go to the hospital and she ended up with another c-section. An outcome that will weigh on both our hearts forever.
In the last few months I have seen another change on the horizon. I believe we are witnessing a new V-BAC era being born. There have been a flurry of studies, articles and announcements about the concern over the rise in our national cesarean rate, balancing risks of repeat c-sections versus v-bac and a woman's right to choose. The National Institute of Health came out with their finding which has pushed ACOG to review it's guidelines and make their own announcement. Read Neergaard's great article to see where we are headed.
By LAURAN NEERGAARD
AP Medical Writer
Most women who've had a C-section, and many who've had two, should be allowed to try labor with their next baby, say new guidelines - a step toward reversing the "once a cesarean, always a cesarean" policies taking root in many hospitals.
Wednesday's announcement by the American College of Obstetricians and Gynecologists eases restrictions on who might avoid a repeat C-section, rewriting an old policy that critics have said is partly to blame for many pregnant women being denied the chance.
Fifteen years ago, nearly 3 in 10 women who'd had a prior C-section gave birth vaginally the next time. Today, fewer than 1 in 10 do.
Last spring, a National Institutes of Health panel strongly urged steps to reverse that trend, saying a third of hospitals and half of doctors ban women from attempting what's called VBAC, for "vaginal birth after cesarean."
The new guidelines declare VBAC a safe and appropriate option for most women - now including those carrying twins or who've had two C-sections - and urge that they be given an unbiased look at the pros and cons so they can decide whether to try.
Women's choice is "what we want to come through loud and clear," said Dr. William Grobman of Northwestern University, co-author of the guidelines. "There are few times where there is an absolute wrong or an absolute right, but there is the importance of shared decision-making."
Overall, nearly a third of U.S. births are by cesarean, an all-time high. Cesareans can be lifesaving but they come with certain risks - and the more C-sections a woman has, the greater the risk in a next pregnancy of problems, some of them life-threatening, like placenta abnormalities or hemorrhage.
The main debate with VBAC: That the rigors of labor could cause the scar from the earlier surgery to rupture. There's less than a 1 percent chance of that happening, the ACOG guidelines say. Also, with most recently performed C-sections, that scar is located on a lower part of the uterus that's less stressed by contractions.
Of those who attempt VBAC, between 60 percent and 80 percent will deliver vaginally, the guidelines note. The rest will need a C-section after all, because of stalled labor or other factors. Success if more likely in women who go into labor naturally - although induction doesn't rule out an attempt - and less likely in women who are obese or are carrying large babies, they say.
Thus the balancing act that women and their doctors weigh: A successful VBAC is safer than a planned repeat C-section, especially for women who want additional children - but an emergency C-section can be riskier than a planned one.
Because of those rare uterine ruptures, the obstetricians' group has long recommended that only hospitals equipped for immediate emergency C-sections attempt VBACs. Many smaller or rural hospitals can't do that, and that recommendation plus high-dollar lawsuits have been blamed for some hospital VBAC bans.
"Restricting access was not the intention," the new guidelines say. They say hospitals ill-equipped for immediate surgery should help women find care elsewhere, have a plan to manage uterine ruptures anyway, and not coerce a woman into a repeat C-section.
Educating women about their options early enough in pregnancy for them to make an informed choice is key, said Dr. F. Gary Cunningham of the University of Texas Southwestern Medical Center, who chaired the NIH panel on repeat C-sections.
It requires a fair portrayal of risks and benefits that can differ by patient, added Dr. Howard Minkoff of Maimonides Medical Center in Brooklyn, N.Y., which has women sign a special VBAC consent after counseling yet has a higher-than-average VBAC rate of 30 percent.
"There's no doubt that how things get framed influences how people act," he said.
While the guidelines cannot force hospital policy changes, some women's groups welcomed them.
"I feel like ACOG has really listened to how their previous policies have impacted women," said Barbara Stratton of the International Cesarean Awareness Network's Baltimore chapter, adding that she'll advise women seeking a VBAC to hand a copy of the guidelines to caregivers who balk.
But she called for reducing overuse of first-time C-sections, too, so that repeats become less of an issue.
Read more: http://www.sanluisobispo.com/2010/07/21/1223164/new-guidelines-aim-to-reduce-repeated.html#ixzz0uQm4tHXf
Friday, July 9, 2010
Popular Antidepressant Linked to Major Birth Defects
The history of Paxil gives us another look at how our medical system, consisting of medical researchers, drug companies, doctors and the FDA, do a poor job protecting moms and their babies. Did you know most drugs aren't even tested initially on women for safety? Men are chosen for testing because they don't have cycles and fluctuating hormones which can affect results. An added benefit to testing only on men is not risking testing on pregnant women which could be a huge liability issue. In my blog piece "Let's Talk about Off Label Use, Cytotec and You" we discussed how difficult it would be to find pregnant women who would willingly sign up to be part of a drug experiment. I explained about one of the ways the drug companies and doctors get around this thorny issue. The Paxil case illustrates another way. It is important to remember that most of what we know about the safety of any given medication taken during pregnancy and lactation is known only in hind sight.
The Story of Paxil, a cautionary tale...
Approved by the FDA in 1992 doctors begin to prescribe it to treat depression, generalized anxiety disorder (GAD), social anxiety disorder, panic disorder (PD), and obsessive compulsive disorder (OCD), and posttraumatic stress disorder (PTSD).
Six years later...
In 1998 the drug company that makes Paxil, GlaxoSmithKline, internal review found an alarmingly high number of Paxil birth defect reports. Early results of two studies showed that women who took Paxil during the first trimester of pregnancy (before they might even know they are pregnant!) were about two times as likely to have a baby with a heart defect as women who received other antidepressants. However, the information was not turned over to the FDA!!!
Seven years later...
In December 2005 the FDA (US Food and Drug Administration) issued a public health advisory warning of increased risk of Paxil birth defects if used while pregnant. Particularly, during the first trimester of pregnancy.
One year later...
The American Medical Association estimated that 40,000 pregnant women in the US were taking antidepressants in 2006. GlaxoSmithKline also stated that in that year about 25 percent of prescriptions for Paxil were written for women of childbearing age.
Two years later...
Paxil generated about $942 million in sales in 2008 from Paxil.
Eighteen years after FDA approval of safety and twelve years after GlaxoSmithKline knows the drug isn't safe for pregnant moms...
In 2010 Paxil is the only SSRI(Selective Serotonin Reuptake Inhibitor) on the market that is classified by the FDA as a Category D drug. Category D means that studies in pregnant women have demonstrated a risk to the fetus. The studies mentioned show a greater risk for babies whose moms took Paxil over other SSRIs. What about comparing the risk between moms who take any SSRIs and moms who don't take any SSRIs? Perhaps we should find out if SSRIs are simply too risky for women of childbearing age unless they are also on a very effective birth control method?
Here's why all SSRIs may be a problem. This group of antidepressants are designed to relieve the symptoms of depression by blocking the reuptake of the chemical serotonin by certain nerve cells in the brain. With more serotonin in the brain, mood is improved. However, Maternal Serotonin plays a crucial role in fetal heart, lung and brain development. Further in the case of Paxil it is known to cross the placenta. So not only are you changing the unique balance of the maternal brain chemicals that effect fetal development you are also directly drugging your growing baby's brain during critical developmental stages.
Paxil, as well as other SSRIs, have been linked to Persistent Pulmonary Hypertension in the Newborn (PPHN) – a devastating condition affecting the heart and lungs of newborn infants. Babies are unable to breathe properly due to constricted blood vessels which cut off oxygen to the blood and cause damage to other organs such as brain and kidneys.
Known Paxil birth defects include:
Spina Bifida: a developmental birth defect caused by the incomplete closure of the embryonic neural tube. Some vertebrae overlying the spinal cord are not fully formed and remain unfused and open. If the opening is large enough, this allows a portion of the spinal cord to protrude through the opening in the bones. There may or may not be a fluid-filled sac surrounding the spinal cord.
Heart Defects: atrial and ventricular septal heart defects (holes in the walls of the chambers of the heart).
Anencephaly: condition in which the portion of the neural tube which will become the cerebrum(the dominant part of the brain) does not close, and encephalocele, which results when other parts of the brain don't appropriately fuse .
These frightening scientific descriptions can never express the personal devastation and family tragedies they represent. My heart breaks.
The Story of Paxil, a cautionary tale...
Approved by the FDA in 1992 doctors begin to prescribe it to treat depression, generalized anxiety disorder (GAD), social anxiety disorder, panic disorder (PD), and obsessive compulsive disorder (OCD), and posttraumatic stress disorder (PTSD).
Six years later...
In 1998 the drug company that makes Paxil, GlaxoSmithKline, internal review found an alarmingly high number of Paxil birth defect reports. Early results of two studies showed that women who took Paxil during the first trimester of pregnancy (before they might even know they are pregnant!) were about two times as likely to have a baby with a heart defect as women who received other antidepressants. However, the information was not turned over to the FDA!!!
Seven years later...
In December 2005 the FDA (US Food and Drug Administration) issued a public health advisory warning of increased risk of Paxil birth defects if used while pregnant. Particularly, during the first trimester of pregnancy.
One year later...
The American Medical Association estimated that 40,000 pregnant women in the US were taking antidepressants in 2006. GlaxoSmithKline also stated that in that year about 25 percent of prescriptions for Paxil were written for women of childbearing age.
Two years later...
Paxil generated about $942 million in sales in 2008 from Paxil.
Eighteen years after FDA approval of safety and twelve years after GlaxoSmithKline knows the drug isn't safe for pregnant moms...
In 2010 Paxil is the only SSRI(Selective Serotonin Reuptake Inhibitor) on the market that is classified by the FDA as a Category D drug. Category D means that studies in pregnant women have demonstrated a risk to the fetus. The studies mentioned show a greater risk for babies whose moms took Paxil over other SSRIs. What about comparing the risk between moms who take any SSRIs and moms who don't take any SSRIs? Perhaps we should find out if SSRIs are simply too risky for women of childbearing age unless they are also on a very effective birth control method?
Here's why all SSRIs may be a problem. This group of antidepressants are designed to relieve the symptoms of depression by blocking the reuptake of the chemical serotonin by certain nerve cells in the brain. With more serotonin in the brain, mood is improved. However, Maternal Serotonin plays a crucial role in fetal heart, lung and brain development. Further in the case of Paxil it is known to cross the placenta. So not only are you changing the unique balance of the maternal brain chemicals that effect fetal development you are also directly drugging your growing baby's brain during critical developmental stages.
Paxil, as well as other SSRIs, have been linked to Persistent Pulmonary Hypertension in the Newborn (PPHN) – a devastating condition affecting the heart and lungs of newborn infants. Babies are unable to breathe properly due to constricted blood vessels which cut off oxygen to the blood and cause damage to other organs such as brain and kidneys.
Known Paxil birth defects include:
Spina Bifida: a developmental birth defect caused by the incomplete closure of the embryonic neural tube. Some vertebrae overlying the spinal cord are not fully formed and remain unfused and open. If the opening is large enough, this allows a portion of the spinal cord to protrude through the opening in the bones. There may or may not be a fluid-filled sac surrounding the spinal cord.
Heart Defects: atrial and ventricular septal heart defects (holes in the walls of the chambers of the heart).
Anencephaly: condition in which the portion of the neural tube which will become the cerebrum(the dominant part of the brain) does not close, and encephalocele, which results when other parts of the brain don't appropriately fuse .
These frightening scientific descriptions can never express the personal devastation and family tragedies they represent. My heart breaks.
Saturday, July 3, 2010
Let's Talk about Off Label Use, Cytotec and You
So you're pregnant. Congratulations! Guess what? Parenting starts now. It doesn't begin after you bring your baby home or even the moment your baby is in your arms. No, your role as protector and nurturer begins from the moment you first realized you were pregnant. You will have a larger role in your child's life than anyone else. You will know your child better than anyone else. You will make more decisions for your child than anyone else and those decisions are more likely to be purely out of a desire to do what is best for your child than anyone else. Being a responsible parent starts now.
What does this have to do with off label use of medications? This has to do with the protector part of your parental responsibilities. So here we go. As I explained in my previous post, "More on Why Women Need to Question Authority" a doctor can legally prescribe a medication for a use for which it has never been tested, in other words no FDA approval. This is called off label use. Apparently this practice is surprisingly common in the medical world.
So what would you do if your doctor came to you when you were pregnant and said, "I want to use drug X on you. It has never been tested for safety in pregnant women or their babies but there is some evidence that it may be effective for your situation." Unless your medical situation was dire most women would say, "Are you kidding? No way!"
What if you went to a prenatal appointment and your doctor or midwife said, "There is a new drug, X, which they are starting to test for FDA approval that might help with keeping blood pressure down during pregnancy. I'd like to sign you and your baby up to be part of the drug trial. Are you interested?" It is hard for me to imagine the mom who would answer, "Sure sign us up!"
So how do they find out if a drug is effective and safe during pregnancy, labor and birth? By doing an end run around you and the safeguards that are in place to protect us from unsafe medications. They go off label. Most medications we commonly use in pregnancy and birth were originally given experimentally on women without their real understanding or consent to the process. Then they collect data in hindsight and try to figure out what is truly OK to be using on us.
Marilyn talks about an example familiar to many of us in her comment on my earlier piece,
"I totally agree with you Jennifer. My mother was given thalidomide for nausea in the 60's and subsequently had three miscarriages and was never able to conceive again."
Most of us have heard about thalidomide babies but we make the mistake of assuming nothing like that could be happening now. That was the kind of thing they used to do in the past before women were treated as equals, right?
Now you are ready to talk about Cytotec. Do you remember the questions I posed in my earlier post?
"Are you seeing a doctor that will induce you if you go past a certain calendar date? Are you worried about being induced? Concerned about ending up on the dreaded "pit drip"? What if your doctor whom you trust said, "don't worry. We're not going to use Pitocin. We're going to use this little tiny pill instead. You won't even need to be hooked to an IV and it is perfectly safe for you and your baby." What would you think? What would you do?"
If facing a labor induction most women would say yes to their doctor or midwife. Their fear of a Pitocin induced labor, which they have heard plenty of bad things about from sisters, mothers and friends, coupled with their fear of ending up with a c-section, added to their trust in their care provider to never do anything to harm them or their babies, and their assumption this pill has been FDA tested for safety in labor, will lead most of them to say yes to their doctor. You have just become an unwitting lab rat.
The truth about Cytotec also known as Misoprostol:
From Wikipedia
In August 2000, Searle—the manufacturer of misoprostol—distributed a letter warning against the use of misoprostol in pregnant women. The letter cited reports of uterine rupture and death associated with using misoprostol to induce labor. Other rare complications include amniotic fluid embolism (a very rare complication which usually results in maternal and fetal death) It is difficult to determine if misoprostol causes a higher risk than do other cervical ripening agents. One estimate is that it would require approximately 61,000 patients enrolled in randomized controlled trials to detect a clinically significant difference in serious fetal complications and approximately 155,000 patients to detect a clinically significant difference in serious maternal complications.
Enter the lab rats. Where on earth are they going to get 155,000 pregnant women to sign up for their experiment? So instead they use Cytotec off label on many more women than 155,000. They have to use many more lab rats because no one is writing down the data. No one is setting up a control group. No one is following up! It takes much more momentum of bad outcomes for moms and babies before the collective consciousness of the medical community realizes the mistake they made.
So how did we get here with Cytotec? When they were testing this drug for it's intended use as an ulcer medication they discovered it was an abortifacient, in other words it caused women to go into labor and miscarry or abort. Someone had the bright idea to use it at the end of pregnancy to cause women to go into labor and birth their babies.
Since there had been no testing for dosing levels for labor induction they needed to wing it. Cytotec is a small white pill. It is only sold in 100ug tablets. They began placing it inside women up against their cervix's where it would slowly be absorbed into the blood stream. Through trial and error they have learned that the best dose is one quarter of one pill or 25ug. Searle the drug manufacturer continues to not sell it in 25ug because they don't want to be legally responsible for what may happen next to you and your baby.
Here comes the tricky part, Pitocin can also cause uterine hyperstimulation which left unchecked can lead to uterine rupture. Here is the difference in what I have seen with my clients. When Cytotec is used they place the pill and wait. With some of my moms absolutely nothing happens, nada, zippo, no contractions at all. Then we all have to wait many hours before they can either try placing a second dose or transfer over to Pitocin. With some moms it works like a charm. They start into strong labor and birth their baby. But what happens to the third group of moms? They get into trouble. Their contractions are coming too strong and too close together. Their baby begins to go into fetal distress. The nurse and doctor have no way of retrieving the pill. They have no way of turning it down or turning it off. With Pitocin they try to find the level of medication which will be strong enough to cause you to contract effectively enough to dilate while not causing contractions so strong they can rupture your uterus or that your baby can't handle. I have seen this dance many times with Pitocin. With Cytotec there is only one way to "rescue" the situation they have created; perform a surgical birth. The mom is rushed down to the OR and she is cut open. Voila! What a lucky thing you had your baby in the hospital otherwise who knows what would have happened!
The American College of Obstetricians and Gynecologists holds that substantial evidence supports the use of misoprostol for induction of labor, a position it reaffirmed in 2000 in response to the Searle drug company disclaimer letter.
When you google Cytotec up come all the law firms preparing cases for grieving families.
Remember Marilyn whose mom took thalidomide? Here's what she had to say as a conscientious parent, "Good rule of thumb - don't take ANYTHING while you're pregnant and before you agree to anything after your child is born - conduct a full spectrum of medical professionals - talk to top homeopathic practitioners, and SEVERAL medical practitioners before you make any decisions. You owe it to yourself and your child to do your homework - don't take anything doctors tell you at face value."
What does this have to do with off label use of medications? This has to do with the protector part of your parental responsibilities. So here we go. As I explained in my previous post, "More on Why Women Need to Question Authority" a doctor can legally prescribe a medication for a use for which it has never been tested, in other words no FDA approval. This is called off label use. Apparently this practice is surprisingly common in the medical world.
So what would you do if your doctor came to you when you were pregnant and said, "I want to use drug X on you. It has never been tested for safety in pregnant women or their babies but there is some evidence that it may be effective for your situation." Unless your medical situation was dire most women would say, "Are you kidding? No way!"
What if you went to a prenatal appointment and your doctor or midwife said, "There is a new drug, X, which they are starting to test for FDA approval that might help with keeping blood pressure down during pregnancy. I'd like to sign you and your baby up to be part of the drug trial. Are you interested?" It is hard for me to imagine the mom who would answer, "Sure sign us up!"
So how do they find out if a drug is effective and safe during pregnancy, labor and birth? By doing an end run around you and the safeguards that are in place to protect us from unsafe medications. They go off label. Most medications we commonly use in pregnancy and birth were originally given experimentally on women without their real understanding or consent to the process. Then they collect data in hindsight and try to figure out what is truly OK to be using on us.
Marilyn talks about an example familiar to many of us in her comment on my earlier piece,
"I totally agree with you Jennifer. My mother was given thalidomide for nausea in the 60's and subsequently had three miscarriages and was never able to conceive again."
Most of us have heard about thalidomide babies but we make the mistake of assuming nothing like that could be happening now. That was the kind of thing they used to do in the past before women were treated as equals, right?
Now you are ready to talk about Cytotec. Do you remember the questions I posed in my earlier post?
"Are you seeing a doctor that will induce you if you go past a certain calendar date? Are you worried about being induced? Concerned about ending up on the dreaded "pit drip"? What if your doctor whom you trust said, "don't worry. We're not going to use Pitocin. We're going to use this little tiny pill instead. You won't even need to be hooked to an IV and it is perfectly safe for you and your baby." What would you think? What would you do?"
If facing a labor induction most women would say yes to their doctor or midwife. Their fear of a Pitocin induced labor, which they have heard plenty of bad things about from sisters, mothers and friends, coupled with their fear of ending up with a c-section, added to their trust in their care provider to never do anything to harm them or their babies, and their assumption this pill has been FDA tested for safety in labor, will lead most of them to say yes to their doctor. You have just become an unwitting lab rat.
The truth about Cytotec also known as Misoprostol:
From Wikipedia
In August 2000, Searle—the manufacturer of misoprostol—distributed a letter warning against the use of misoprostol in pregnant women. The letter cited reports of uterine rupture and death associated with using misoprostol to induce labor. Other rare complications include amniotic fluid embolism (a very rare complication which usually results in maternal and fetal death) It is difficult to determine if misoprostol causes a higher risk than do other cervical ripening agents. One estimate is that it would require approximately 61,000 patients enrolled in randomized controlled trials to detect a clinically significant difference in serious fetal complications and approximately 155,000 patients to detect a clinically significant difference in serious maternal complications.
Enter the lab rats. Where on earth are they going to get 155,000 pregnant women to sign up for their experiment? So instead they use Cytotec off label on many more women than 155,000. They have to use many more lab rats because no one is writing down the data. No one is setting up a control group. No one is following up! It takes much more momentum of bad outcomes for moms and babies before the collective consciousness of the medical community realizes the mistake they made.
So how did we get here with Cytotec? When they were testing this drug for it's intended use as an ulcer medication they discovered it was an abortifacient, in other words it caused women to go into labor and miscarry or abort. Someone had the bright idea to use it at the end of pregnancy to cause women to go into labor and birth their babies.
Since there had been no testing for dosing levels for labor induction they needed to wing it. Cytotec is a small white pill. It is only sold in 100ug tablets. They began placing it inside women up against their cervix's where it would slowly be absorbed into the blood stream. Through trial and error they have learned that the best dose is one quarter of one pill or 25ug. Searle the drug manufacturer continues to not sell it in 25ug because they don't want to be legally responsible for what may happen next to you and your baby.
Here comes the tricky part, Pitocin can also cause uterine hyperstimulation which left unchecked can lead to uterine rupture. Here is the difference in what I have seen with my clients. When Cytotec is used they place the pill and wait. With some of my moms absolutely nothing happens, nada, zippo, no contractions at all. Then we all have to wait many hours before they can either try placing a second dose or transfer over to Pitocin. With some moms it works like a charm. They start into strong labor and birth their baby. But what happens to the third group of moms? They get into trouble. Their contractions are coming too strong and too close together. Their baby begins to go into fetal distress. The nurse and doctor have no way of retrieving the pill. They have no way of turning it down or turning it off. With Pitocin they try to find the level of medication which will be strong enough to cause you to contract effectively enough to dilate while not causing contractions so strong they can rupture your uterus or that your baby can't handle. I have seen this dance many times with Pitocin. With Cytotec there is only one way to "rescue" the situation they have created; perform a surgical birth. The mom is rushed down to the OR and she is cut open. Voila! What a lucky thing you had your baby in the hospital otherwise who knows what would have happened!
The American College of Obstetricians and Gynecologists holds that substantial evidence supports the use of misoprostol for induction of labor, a position it reaffirmed in 2000 in response to the Searle drug company disclaimer letter.
When you google Cytotec up come all the law firms preparing cases for grieving families.
Remember Marilyn whose mom took thalidomide? Here's what she had to say as a conscientious parent, "Good rule of thumb - don't take ANYTHING while you're pregnant and before you agree to anything after your child is born - conduct a full spectrum of medical professionals - talk to top homeopathic practitioners, and SEVERAL medical practitioners before you make any decisions. You owe it to yourself and your child to do your homework - don't take anything doctors tell you at face value."
Thursday, July 1, 2010
While Waiting
This quiet mom sent along this nice note while waiting out the days to go into labor.
"Dear Jennifer,
I want to thank you for all the help you have given us in preparing for this birth & baby. Your classes were really informative & encouraging. Nothing has happened yet & its Saturday, so we're just waiting & getting ready (trying to...) Anyways, your knowledge & attitude toward birth has really helped me. I'll do my best to let you know when & how the baby arrives. Until then, take care.
Ryanne
P.S. Thank you for having us @ your home for the last class. :)
"Dear Jennifer,
I want to thank you for all the help you have given us in preparing for this birth & baby. Your classes were really informative & encouraging. Nothing has happened yet & its Saturday, so we're just waiting & getting ready (trying to...) Anyways, your knowledge & attitude toward birth has really helped me. I'll do my best to let you know when & how the baby arrives. Until then, take care.
Ryanne
P.S. Thank you for having us @ your home for the last class. :)
Congratulations on a Successful V-BAC!
Dear Anna, Thank you for letting me share in your journey. Your acceptance of the challenges and possible risks along your path are an inspiration. You never lost sight of your strong belief that women were meant to have babies. You embody true female empowerment which is vulnerable, thoughtful, physical and heroic. Congratualtions on bringing into this world your beautiful 9 pound 13 ounce baby girl, Paloma!
More on Why Women Need to Question Authority
From Joe Stover
Sent June 30th
"Hey Mom you should check out this article. It's kind of hard to believe/disturbing."
My son sent me this message and a link to a blog site the day after my post claiming women were being lied to and manipulated by the medical/money machine. He was deeply concerned about pregnant women being given a drug to prevent girl babies from growing up to have typical "masculine" traits. These girls are being labled abnormal because they show a lack of interest in playing with dolls or fantasizing about having babies and they grow up to have little interest in getting married and taking on traditional wife and motherhood roles.
So I looked into it and as justified and disturbing as his concerns were was a bigger issue for me. Once again women and their babies are being experimented upon by the medical establishment without their knowledge or consent. How can that happen you ask? It isn't like someone is sneaking in while the women sleep and are giving them a drug. Of course not; it is much more insidious than that. It involves something few women understand thoroughly called off label use. Don't believe me? Here are two women's stories excerpted from an article that just came out in Time magazine June 18th.
Jenny Westphal, 24, who took dexamethasone throughout her pregnancy at the recommendation of a doctor, says she feels misled. . . She was not asked to give informed consent. Her daughter, now 3, who has CAH (the disorder they were trying to prevent with the dexamethasone!) has had serious and mysterious health problems since birth, including feeding disorders, that are not commonly associated with her adrenal-gland disorder. . . In April, Westphal, who lives in Wisconsin, started doing research online and discovered there was some controversy over the treatment. "I was outraged, frustrated and confused. Confused, because no one had ever warned me about this. I wasn't given the chance to decide for myself, based on the risks and benefits, if I wanted the treatment or not," she says . . . Westphal may never know whether her daughter's problems were caused by dexamethasone, though she will likely always believe they were. That is why so many similar situations, in which experimental drugs are prescribed off-label without informed consent rather than in clinical trials, wind up becoming case studies — not in scientific journals, but exactly where Westphal and her husband are considering taking theirs: to court.
When Marisa Langford found out she was pregnant again, she called Dr. Maria New, a total stranger, before calling her own mother. New, a prominent pediatric endocrinologist and researcher at Mount Sinai Medical Center in New York City, is one of the world's foremost experts in congenital adrenal hyperplasia, or CAH . . . Langford and her husband learned they were silent carriers of the genetic variation that causes CAH when their son was diagnosed with the condition after birth. . . "Dr. New told me I had to start taking dexamethasone immediately," says Langford, 30, who lives in Tampa. "We felt very confident in someone of her stature and that what she was telling us was the right thing to do." . . . Langford says that neither New nor her prescribing physician mentioned that prenatal dexamethasone treatment is an off-label use of the drug (an application for which it was not specifically approved by the government) or that the medical community is sharply divided over whether dexamethasone should be used during pregnancy at all.
In animal studies, dexamethasone has been shown to cause birth defects, but proponents of the treatment note that no human birth defects have ever been associated with the treatment, and that it is uncertain whether findings in lab animals translate to humans. . . "We just don't know what we are doing to these kids," says Dr. Walter Miller, the chief of endocrinology at University of California, San Francisco. "It's not sufficient to say, The baby was born and had all fingers and toes, so it's fine."
Perhaps most controversially, prenatal dex must be given as soon as a woman learns she is pregnant, which is usually several weeks before genetic tests can determine if the fetus is in fact a female affected with CAH — the chance of which is 1 in 8 for parents who already have an affected child or know they are carriers of the genetic disorder. If the baby is healthy, treatment is stopped, but at that point, the fetus has been exposed to the steroid drug for weeks. There is no data on how many mothers receive prenatal dex, but according to the odds, 7 of 8 may be taking medication unnecessarily.
OMG!!! 7 out of 8 don't need it, no long term studies have been done on the safety of the drug for the baby when given prenatally, the women aren't being informed that this is the case? OMG! OMG! OMG! How can this be? What the hell is this off label use thing all about?
Basically it comes down to the fact that any doctor can prescribe medication for anything they want. It doesn't have to first be tested for effectiveness on what the doctor is choosing to use it to treat. It doesn't have to first be tested for safety when used for this purpose. It doesn't have to first be studied for proper dosaging when used for this purpose. In other words when you are given a drug off label they are using you to experiment upon.
So why do doctors do it? Let's head back to the Time article to find out.
It enables doctors to do human research without gaining proper approval. All participants in human medical research are, by law, entitled to the protective oversight of an institutional review board (IRB), a committee that safeguards the interests of research volunteers and ensures they have been fully informed about the potential risks and benefits of an experimental treatment. If doctors are simply treating a patient with an off-label drug, they are not required to obtain written informed consent from patients. But if doctors give treatment with the intent to gain knowledge, they are technically doing research, which must receive IRB approval. . . Ethicists say physicians may sometimes treat patients off-label, then decide later to launch a follow-up study; or, they do follow-up research on patients who have been treated by other doctors. In the process, they have converted these patients into unwitting research volunteers. Some doctors game the system this way, Caplan says, to avoid battles with IRBs.
And there are battles. In the case of prenatal use of dexamethasone there is currently a battle between a Dr. Maria New, a prominent pediatric endocrinologist and researcher at Mount Sinai Medical Center in New York and some members of the Bioethics Forum. They are doing what they can to shut her down with letters, articles and general publicity. And then of course there are the court battles. Remember Jenny Westphal and her 3 year old daughter with mysterious ailments? They are doing just that, taking the doctors to court.
So you think this doesn't effect you since you don't carry the gene for this rare disorder? Think again. Was you labor induced? Are you seeing a doctor that will induce you if you go past a certain calendar date? Are you worried about being induced? Concerned about ending up on the dreaded "pit drip"? What if your doctor whom you trust said, "don't worry. We're not going to use pitocin. We're going to use this little tiny pill instead. You won't even need to be hooked to an IV and it is perfectly safe for you and your baby." What would you think? What would you do? More on this wonder drug and off label use next time.
Time article
http://www.time.com/time/health/article/0,8599,1996453,00.html#ixzz0sNjIwE7D
Letter of concern sent to the CARES Foundation
(Congenital Adrenal Hyperplasia Research Education & Support)
http://www.fetaldex.org/letter_CARES.html
Bioethics Forum
Preventing Homosexuality (and Uppity Women) in the Womb?
Alice Dreger, Ellen K. Feder, Anne Tamar-Mattis, 06/29 http://www.thehastingscenter.org/Bioethicsforum/Post.aspx?id=4754&blogid=140
Sent June 30th
"Hey Mom you should check out this article. It's kind of hard to believe/disturbing."
My son sent me this message and a link to a blog site the day after my post claiming women were being lied to and manipulated by the medical/money machine. He was deeply concerned about pregnant women being given a drug to prevent girl babies from growing up to have typical "masculine" traits. These girls are being labled abnormal because they show a lack of interest in playing with dolls or fantasizing about having babies and they grow up to have little interest in getting married and taking on traditional wife and motherhood roles.
So I looked into it and as justified and disturbing as his concerns were was a bigger issue for me. Once again women and their babies are being experimented upon by the medical establishment without their knowledge or consent. How can that happen you ask? It isn't like someone is sneaking in while the women sleep and are giving them a drug. Of course not; it is much more insidious than that. It involves something few women understand thoroughly called off label use. Don't believe me? Here are two women's stories excerpted from an article that just came out in Time magazine June 18th.
Jenny Westphal, 24, who took dexamethasone throughout her pregnancy at the recommendation of a doctor, says she feels misled. . . She was not asked to give informed consent. Her daughter, now 3, who has CAH (the disorder they were trying to prevent with the dexamethasone!) has had serious and mysterious health problems since birth, including feeding disorders, that are not commonly associated with her adrenal-gland disorder. . . In April, Westphal, who lives in Wisconsin, started doing research online and discovered there was some controversy over the treatment. "I was outraged, frustrated and confused. Confused, because no one had ever warned me about this. I wasn't given the chance to decide for myself, based on the risks and benefits, if I wanted the treatment or not," she says . . . Westphal may never know whether her daughter's problems were caused by dexamethasone, though she will likely always believe they were. That is why so many similar situations, in which experimental drugs are prescribed off-label without informed consent rather than in clinical trials, wind up becoming case studies — not in scientific journals, but exactly where Westphal and her husband are considering taking theirs: to court.
When Marisa Langford found out she was pregnant again, she called Dr. Maria New, a total stranger, before calling her own mother. New, a prominent pediatric endocrinologist and researcher at Mount Sinai Medical Center in New York City, is one of the world's foremost experts in congenital adrenal hyperplasia, or CAH . . . Langford and her husband learned they were silent carriers of the genetic variation that causes CAH when their son was diagnosed with the condition after birth. . . "Dr. New told me I had to start taking dexamethasone immediately," says Langford, 30, who lives in Tampa. "We felt very confident in someone of her stature and that what she was telling us was the right thing to do." . . . Langford says that neither New nor her prescribing physician mentioned that prenatal dexamethasone treatment is an off-label use of the drug (an application for which it was not specifically approved by the government) or that the medical community is sharply divided over whether dexamethasone should be used during pregnancy at all.
In animal studies, dexamethasone has been shown to cause birth defects, but proponents of the treatment note that no human birth defects have ever been associated with the treatment, and that it is uncertain whether findings in lab animals translate to humans. . . "We just don't know what we are doing to these kids," says Dr. Walter Miller, the chief of endocrinology at University of California, San Francisco. "It's not sufficient to say, The baby was born and had all fingers and toes, so it's fine."
Perhaps most controversially, prenatal dex must be given as soon as a woman learns she is pregnant, which is usually several weeks before genetic tests can determine if the fetus is in fact a female affected with CAH — the chance of which is 1 in 8 for parents who already have an affected child or know they are carriers of the genetic disorder. If the baby is healthy, treatment is stopped, but at that point, the fetus has been exposed to the steroid drug for weeks. There is no data on how many mothers receive prenatal dex, but according to the odds, 7 of 8 may be taking medication unnecessarily.
OMG!!! 7 out of 8 don't need it, no long term studies have been done on the safety of the drug for the baby when given prenatally, the women aren't being informed that this is the case? OMG! OMG! OMG! How can this be? What the hell is this off label use thing all about?
Basically it comes down to the fact that any doctor can prescribe medication for anything they want. It doesn't have to first be tested for effectiveness on what the doctor is choosing to use it to treat. It doesn't have to first be tested for safety when used for this purpose. It doesn't have to first be studied for proper dosaging when used for this purpose. In other words when you are given a drug off label they are using you to experiment upon.
So why do doctors do it? Let's head back to the Time article to find out.
It enables doctors to do human research without gaining proper approval. All participants in human medical research are, by law, entitled to the protective oversight of an institutional review board (IRB), a committee that safeguards the interests of research volunteers and ensures they have been fully informed about the potential risks and benefits of an experimental treatment. If doctors are simply treating a patient with an off-label drug, they are not required to obtain written informed consent from patients. But if doctors give treatment with the intent to gain knowledge, they are technically doing research, which must receive IRB approval. . . Ethicists say physicians may sometimes treat patients off-label, then decide later to launch a follow-up study; or, they do follow-up research on patients who have been treated by other doctors. In the process, they have converted these patients into unwitting research volunteers. Some doctors game the system this way, Caplan says, to avoid battles with IRBs.
And there are battles. In the case of prenatal use of dexamethasone there is currently a battle between a Dr. Maria New, a prominent pediatric endocrinologist and researcher at Mount Sinai Medical Center in New York and some members of the Bioethics Forum. They are doing what they can to shut her down with letters, articles and general publicity. And then of course there are the court battles. Remember Jenny Westphal and her 3 year old daughter with mysterious ailments? They are doing just that, taking the doctors to court.
So you think this doesn't effect you since you don't carry the gene for this rare disorder? Think again. Was you labor induced? Are you seeing a doctor that will induce you if you go past a certain calendar date? Are you worried about being induced? Concerned about ending up on the dreaded "pit drip"? What if your doctor whom you trust said, "don't worry. We're not going to use pitocin. We're going to use this little tiny pill instead. You won't even need to be hooked to an IV and it is perfectly safe for you and your baby." What would you think? What would you do? More on this wonder drug and off label use next time.
Time article
http://www.time.com/time/health/article/0,8599,1996453,00.html#ixzz0sNjIwE7D
Letter of concern sent to the CARES Foundation
(Congenital Adrenal Hyperplasia Research Education & Support)
http://www.fetaldex.org/letter_CARES.html
Bioethics Forum
Preventing Homosexuality (and Uppity Women) in the Womb?
Alice Dreger, Ellen K. Feder, Anne Tamar-Mattis, 06/29 http://www.thehastingscenter.org/Bioethicsforum/Post.aspx?id=4754&blogid=140
Tuesday, June 29, 2010
Understanding U.S. Birth Trends & How They Might Effect You
Currently there is a lot of buzz about our high cesarean section rate and trying to lower it. Why? Because the statistics are starting to bear out what many of us have been saying for years, that doing more cesareans doesn't mean better care or better results. Furthermore that moms are getting a tremendous amount of pressure from their doctors to have C-sections and that c-sections put moms at more risk with no improvement in benefits for babies. This video is a good explaination of current trends in our birth culture and medical practices. It goes on to show how these trends are effecting our cesarean section rates, maternal out-comes and baby out-comes.
My thoughts on the statistics coming out about c-sections:
What an outrage has been perpetrated on women yet again! The rising birth surgery rate in the last 10 years is an appalling abuse of power. This is just one more time in a long list of times when our society's views on women and it's values of pursuing science and money have blended with the male dominated medical model to put women in harms way. Women, just as other minorities within our culture, have been used and abused at the alter of the medical machine once again.
Young mother's today haven't grown up with the mantra, "Question Authority!" or the understanding of the true balance of power between men and women built into our system. They have grown up in a Hillary Clinton world where women like Meg Whitman appear to be able to have a firm grasp on the levers of power in the financial and political world. They don't understand that these women are an aberration. They are an illusion. In the world I live in thousands of women everyday are being lied to or at the very least subltly manipulated into turning their bodies over for someone else's monetary gain. And the propoganda is so good most of them have no idea what just happened to them. They actually believe that their rapists are their saviors. How sick is that? They arrive home dazed and in pain with only one clear thought, how grateful they are to their doctor for saving them and their baby.
I have one thing to say to young women today, "Wake up!! Stop drinking the kool-aid! Question Authority!" Just because Authority wears a white lab coat and has a degree behind the desk doesn't mean he or she has only your best interest at heart. Don't let yourself be a cog in the wheel of the great machine. Take a cue from your hippie sisters of the sixties and reclaim your right to your bodies and your births. You deserve it.
GET EDUCATED! WATCH THIS VIDEO: http://www.lamaze.org/OnlineCommunity/LamazeVideoLibrary/LamazeVideoPlayer/TabId/808/VideoId/4/Birth-By-The-Numbers.aspx
My thoughts on the statistics coming out about c-sections:
What an outrage has been perpetrated on women yet again! The rising birth surgery rate in the last 10 years is an appalling abuse of power. This is just one more time in a long list of times when our society's views on women and it's values of pursuing science and money have blended with the male dominated medical model to put women in harms way. Women, just as other minorities within our culture, have been used and abused at the alter of the medical machine once again.
Young mother's today haven't grown up with the mantra, "Question Authority!" or the understanding of the true balance of power between men and women built into our system. They have grown up in a Hillary Clinton world where women like Meg Whitman appear to be able to have a firm grasp on the levers of power in the financial and political world. They don't understand that these women are an aberration. They are an illusion. In the world I live in thousands of women everyday are being lied to or at the very least subltly manipulated into turning their bodies over for someone else's monetary gain. And the propoganda is so good most of them have no idea what just happened to them. They actually believe that their rapists are their saviors. How sick is that? They arrive home dazed and in pain with only one clear thought, how grateful they are to their doctor for saving them and their baby.
I have one thing to say to young women today, "Wake up!! Stop drinking the kool-aid! Question Authority!" Just because Authority wears a white lab coat and has a degree behind the desk doesn't mean he or she has only your best interest at heart. Don't let yourself be a cog in the wheel of the great machine. Take a cue from your hippie sisters of the sixties and reclaim your right to your bodies and your births. You deserve it.
GET EDUCATED! WATCH THIS VIDEO: http://www.lamaze.org/OnlineCommunity/LamazeVideoLibrary/LamazeVideoPlayer/TabId/808/VideoId/4/Birth-By-The-Numbers.aspx
Sunday, June 27, 2010
More Confessions
In my teens our middle school’s marching band sold huge See’s Candies’ chocolate bars to raise money. I was a huge supporter; buying a candy bar each day for lunch and washing it down with a Hawaiian Punch. My future mother-in-law was a really good cook. When I met my husband one of his favorite meals included lime Jello with bananas as a “salad.” Wanting to live up to his mother’s high standards I dutifully made it for him at every holiday. When it wasn’t a holiday I was busy being a horsewoman. Every day I would dash out of the house in the morning after drinking my very sugary tea and munching down cinnamon toast for breakfast. Then I would skip lunch all together. I didn’t even bring anything to drink with me! I rarely came home to cook dinner until well after dark when all the horse chores were done. Tired and late I would throw together a meal, such as, 3 Can Chili (1 can of chili, 1 can or corn and 1 can of stewed tomatoes) and pour it over white rice. Viola! Dinner was served. I weighed 101 pounds from the time I was 14 or 15 until I was 32. Luckily my son rescued me from myself. When I had difficulty getting pregnant one of the things I did to help my fertility was force myself to eat more in order to gain 5 or 10 pounds. I ate 3 meals a day and began to care about what I put into my body. At first I added simple things, such as Yoplait yogurt and an apple for lunch. Later I branched out into actual peanut butter and jam or lunch meat sandwiches. I cut out my tea to get off all caffeine which took sugar out of my morning routine.
During my pregnancy I tried to eat all the “servings’ they recommended in “What to Expect When You are Expecting.” I also thought it was fine to eat all the ice cream I wanted and I am ashamed to say I became addicted to Jello chocolate pudding cups. I still wasn’t drinking enough throughout the day and would gulp down a huge glass of cold apple juice as soon as I got in the door at night. I told myself it was a serving of fruit instead of the sugar fix it was really. I passed my gestational diabetes test but I don’t know how. I must have been right on the cusp. If I had failed it, I would have had an opportunity to reroute my eating habits earlier in my life. I felt so bad after driving back from the test I crawled into my truck at the barn and fell asleep for the afternoon. I blame all the sugar in that darned apple juice for the size of my son and the number of hours it took me to finally push him out.
Breastfeeding went really well for me. I produced plenty and he nursed plenty. He grew like mad and no one could believe that little old me had a baby at the top of the height and weight chart at every pediatrician visit. The biggest change for me at this point was taking foods out of my diet that didn’t agree with my son. I learned I could live without dairy, although I craved it. I began to understand how my digestion and some other health issues seemed to be connected to consuming dairy. The other change was getting off the juice and drinking water instead. It took a few rounds of plugged ducts to get me paying attention to my fluid intake throughout the day.
Toddlerhood kept me running. I was busy with horses, my son and starting my doula business. Meanwhile Joe still didn’t sleep through the night. I felt like I was a walking zombie. I finally took myself to an endocrinologist for testing. She explained to me that although I was not diabetic I had what she called a diabetic body type. I needed to get off sugars of all kinds and start eating protein with every meal. I jumped in with both feet and followed her advice religiously for a few years. I definitely felt better. I learned how a sugar rush felt and why I had nausea and shakiness sometimes from the drop off on the other side. Meanwhile I was no longer eating for two but I was constantly cooking for two. Food or thoughts about food are never far from a mother’s mind. I learned to take snacks with me ALL the time after Joe had a major melt down in a bank line. But was I feeding him wholesome organic food? No way. He adored corn dogs from Costco with Kraft Mac and Cheese. He ate Cheerios for breakfast and I felt virtuous because I added a banana and no sugar. After he went to a friend’s house and encountered Sugar Smacks was the first time he told me I was WAY TOO strict about eating. He had PBJ’s or bologna sandwiches for lunch. Hey, but it was on wheat bread. Darned if MY kid was eating those sugar butter sandwiches! Of course for special occasions I would make homemade cinnamon toast which essentially was an open faced toasted sugar butter sandwich with cinnamon but it was on WHOLE WHEAT bread. That should count for something right? Now life really began changing for our family and I blame it all on the company I was keeping. I began to meet moms who were eating and feeding their kids very differently than I. These women were La Leche League members, midwifery assistants and homeschoolers. I finally began to see food in a whole new light. I started thinking about what the heck was IN a corn dog and what made those sandwich crackers that brilliant orange? Well my family might say it was all downhill from there. I was the soccer mom who brought for everyone after the game homemade pumpkin muffins made with whole wheat flour and sweetened with applesauce along with a bottle of water as a snack. What no sugary drink box? No candy? No cup cake thick with frosting? What kind of mom ARE you? My son ate smoothies for lunch with whole fruit and tofu. We rarely ate at a fast food place. Veggies always have a place at my table, even if I have had to let my son dip them in ranch dressing to get them eaten. I am learning all the time about what constitutes good nutrition and incorporating it into our meals.
Of course different people have different thoughts on nutrition. For me it involves good quality protein, pesticide free fresh fruits and veggies from our local farmer’s market or farm stands, organic dairy and eggs with no hormones or antibiotics. I am slowly converting my family to whole wheat pasta. They already have decided brown rice is ok. They will even eat quinoa and millet occasionally. Any meal I make has veggies or fruit as an important component. Salad happens several nights a week and is often the main course. My veggies are raw, steamed or sautéed. Plain fruit is often our dessert.
But I am definitely not as crunchy and organic as some young moms these days. Today I sat on the grass in the park and listened to a mom talk about not only making her own bread but grinding her own wheat. It made me tired just to think of it! I’m sure her bread DOES taste better and IS more nutritious but I’m not ready to devote that much of my life to food preparation.
Three years ago my son went off to college and the issue of food became an uncharted frontier for us; a land where I had no control. For the first 2 years I got to hear him complain about dorm food. It appalled me what they were serving. After all they had led me to believe they were a progressive northwestern liberal arts school. Didn’t they know anything about nutrition? Even worse my son was working for the college food service company and saw how they MADE the food. But more troubling for me was how often he was getting sick. I absolutely blame his diet. Last year he moved into an apartment and I put together a recipe book for him and packed up many of the basic ingredients; the spices and non-perishable items. I encouraged him to find out where the local health food store was located and if there was a farmer’s market. Then I sat back, crossed my fingers and tried hard not to think about it. Here is what I learned. He won’t starve. He can cook. He also won’t take the time and energy needed to buy fresh, organic and local. He still LOVES Mac and Cheese. Hearing he made himself a pot of Top Ramen with real veggies actually makes me happy. I don’t think he eats any fruit which makes me sad. He still gets sick way to often and I still blame his diet. I try not to nag. When he is home in the summer I have the urge to get as much nutritious food down him as possible but it is tricky. He makes his own breakfast and lunch. Although I have many healthy options for him to choose from he gravitates to carbs and will eat a lot of bagels, toast, and muffins. Sometimes he’ll eat all of them at 1 meal! But dinners are mine to create and I stuff as much goodness into them as possible. Tonight is nitrate free organic chicken and apple sausage with potatoes, carrots, broccoli, zucchini, green onions, corn and peppers sautéed together in a pan. Everything will be fresh and good and he will happily wolf it down. 
Teaching Nutrition: As a birth educator and doula I have been teaching women about nutrition for many years. Every time I learn something new I pass it on. Nutrition in pregnancy is critically important to the health of the mother, to the life-long health of the baby and to the health and safety of the pregnancy. Many common pregnancy related problems, and more serious complications can be resolved through appropriate nutrition. Issues such as gestational diabetes or high blood pressure can be turned around. Food is the true path to life-long wellness. Finding ways to get people to make such fundamental changes is the difficulty. I know that the first step is becoming aware of what you are doing. Then you have to have a strong reason to change. For many women they will make changes for their child’s sake that they wouldn’t make for themselves. Finally they need simple ways to make those changes over time. It is important to keep in mind very few people are ready to massively overhaul their diet all at once. Our diet is intertwined with our culture, our family and our life style. These have strong holds over people. So I encourage moms to change out white rice for brown, add in fruit with breakfast, or eat a high quality protein snack instead of reaching for a cup of coffee or a sweet. Building awareness and taking baby steps with each meal is the best way to make a change that will last. I know if I can make an impact on how a mother views food during her pregnancy I potentially can impact her whole family for life. 
Learn about my Healthy Beginnings/Healthy Choices class series here.
Don't miss all the ways you can Create a Healthy Pregnancy.
Tuesday, June 22, 2010
Attachment Parenting cont.
Thoughts on Attachment Parenting
By Emily Phifer, M.S. MFT
There are two things that I think of as foundational to parenting with an attachment basis: 1.) Babies and children are incredibly impressionable and everything that happens is an opportunity for imprinting or shaping the child’s mind, body, emotions and psyche as well as relationships with self and other. 2.) Parents aren’t perfect, and when there is a “rupture” or disruption in ideal attachment with our children, there is a golden opportunity for deeper attachment and connection in the repair. Learning and growing can be modeled for children through the care and commitment of caregivers who are willing to admit mistakes/ disconnects and work to repair them. Parenting children with humility and respect is of utmost importance.
Additionally, I think of attachment parenting as knowing that I'm in an intimate and intentional process of mirroring my baby, responding to her needs, and helping to develop a safe and secure attachment for her in the world as she learns and grows (my husband and I are a team in this). On a daily basis, this mirroring and responding entails talking to Lucia as we go about our activities, showing her that I hear her sounds and see her actions, and that I am tracking her responses to the world around her. This might mean I praise or mimic her attempts at sounds or voice inflections, that I mirror her excitement over spotting the kitty across the room, or acknowledge her frustration when I prevent her from playing with something that isn’t safe or permissible.
Physically, I make daily effort to sit with Lucia and make good eye contact as she plays and explores, interacting with hand pats, hugs and facial expressions to show her that I am encouraging her exploration and developmental play. Mirroring Lucia’s excitement over playing with apples and measuring cups on the kitchen floor is a way to reinforce that what matters to her matters to me, and that her being is valid and important in our world. This modeling translates into Lucia’s internal world of secure attachment and development as a healthy self.
I want her to know that her needs and feelings and experiences matter to my husband and I and we will do our best to respond. When she hurts herself during crawling and exploration play, we pick her up, soothe her and acknowledge that it doesn’t feel good to get hurt, and that we’re there to comfort and help her while she’s hurting. We also model that once Lucia feels better, she is encouraged to return to playing and exploring once again with confidence that help, care and safety are available. Lucia has the opportunity to internalize this security while having space and encouragement to explore the world around her.
We can't be perfect as parents, but when we make mistakes, we can make repairs in our bond with our baby, making the attachment even stronger. On days where I’ve grown frustrated with Lucia for one reason or another, I sometimes make a determination to "press the reset button" on my patience and admit to her that I haven't been the best I can be for her. I apologize to her, and acknowledge that we’re going to try again, to work together to move forward, learning and growing together. Our family needs to have grace for one another as we learn and grow as individuals, and as a family unit.
I also recognize that there must be room for my own self care as I care for my baby- so I have to find a balance of caring for myself and my marriage, while responding as best as I can to my baby's needs. This has perhaps been the biggest challenge for me in being a new parent, as a baby’s needs can be all-encompassing and, at times, demanding. Self care and balance in our family life includes finding little ways to nurture my own care (reading, going for a walk, listening to favorite music, coffee with a friend) and that of my marriage (comparing notes from the day, sitting down for a meal at the table together after Lucia is in bed, watching a show in the evening or getting away for a date). Attuning to our baby is a physical, emotional, spiritual and mental journey. Healthy attachment is a foundational and life-giving gift we can give to our children.
By Emily Phifer, M.S. MFT
There are two things that I think of as foundational to parenting with an attachment basis: 1.) Babies and children are incredibly impressionable and everything that happens is an opportunity for imprinting or shaping the child’s mind, body, emotions and psyche as well as relationships with self and other. 2.) Parents aren’t perfect, and when there is a “rupture” or disruption in ideal attachment with our children, there is a golden opportunity for deeper attachment and connection in the repair. Learning and growing can be modeled for children through the care and commitment of caregivers who are willing to admit mistakes/ disconnects and work to repair them. Parenting children with humility and respect is of utmost importance.Additionally, I think of attachment parenting as knowing that I'm in an intimate and intentional process of mirroring my baby, responding to her needs, and helping to develop a safe and secure attachment for her in the world as she learns and grows (my husband and I are a team in this). On a daily basis, this mirroring and responding entails talking to Lucia as we go about our activities, showing her that I hear her sounds and see her actions, and that I am tracking her responses to the world around her. This might mean I praise or mimic her attempts at sounds or voice inflections, that I mirror her excitement over spotting the kitty across the room, or acknowledge her frustration when I prevent her from playing with something that isn’t safe or permissible.
Physically, I make daily effort to sit with Lucia and make good eye contact as she plays and explores, interacting with hand pats, hugs and facial expressions to show her that I am encouraging her exploration and developmental play. Mirroring Lucia’s excitement over playing with apples and measuring cups on the kitchen floor is a way to reinforce that what matters to her matters to me, and that her being is valid and important in our world. This modeling translates into Lucia’s internal world of secure attachment and development as a healthy self.
I want her to know that her needs and feelings and experiences matter to my husband and I and we will do our best to respond. When she hurts herself during crawling and exploration play, we pick her up, soothe her and acknowledge that it doesn’t feel good to get hurt, and that we’re there to comfort and help her while she’s hurting. We also model that once Lucia feels better, she is encouraged to return to playing and exploring once again with confidence that help, care and safety are available. Lucia has the opportunity to internalize this security while having space and encouragement to explore the world around her.
We can't be perfect as parents, but when we make mistakes, we can make repairs in our bond with our baby, making the attachment even stronger. On days where I’ve grown frustrated with Lucia for one reason or another, I sometimes make a determination to "press the reset button" on my patience and admit to her that I haven't been the best I can be for her. I apologize to her, and acknowledge that we’re going to try again, to work together to move forward, learning and growing together. Our family needs to have grace for one another as we learn and grow as individuals, and as a family unit.
I also recognize that there must be room for my own self care as I care for my baby- so I have to find a balance of caring for myself and my marriage, while responding as best as I can to my baby's needs. This has perhaps been the biggest challenge for me in being a new parent, as a baby’s needs can be all-encompassing and, at times, demanding. Self care and balance in our family life includes finding little ways to nurture my own care (reading, going for a walk, listening to favorite music, coffee with a friend) and that of my marriage (comparing notes from the day, sitting down for a meal at the table together after Lucia is in bed, watching a show in the evening or getting away for a date). Attuning to our baby is a physical, emotional, spiritual and mental journey. Healthy attachment is a foundational and life-giving gift we can give to our children.
OK ready to learn more about parenting in an attached rather than a detached or unattached way?
Listen to our discussion on KVEC.
Come to a gathering of my South County Holistic Mamas and Papas and listen, watch and learn. Ask to join the facebook group to get invites.
Attend a La Leche League meeting near you. Meetings in SLO & Los Osos. I'll soon be leading meetings in the South County! Not from SLO?
Learn the 8 principals of Attached Parenting.
Read a book! I recommend these books:
The Continuum Concept by Jean Liedloff, one of the founders of this cultural change, who took a fresh look at parenting from an anthropological/cultural point of view and sparked a fire that is still going
Attachment Parenting Book by William and Martha Sears, Dr. Sears is the beloved author of many books including The Baby Book a must read by this generation of parents.
Attached at the Heart by Barbara Nicholson and Lysa Parker, the founders of Attachment Parenting International
Check out Attachment Parenting International.
I believe every family is unique and each person within that family is unique. As parents we are faced with daily challenges. One of those challenges is trying to be the best parent we can be at any given moment to each of our kids. There is no one right answer for every person but every human being deserves to be raised with respect, compassion and understanding. Finally I leave you with this statement which is said at every La Leche League meeting,
"Take what works for your family and leave the rest."
Wednesday, June 16, 2010
Good News about V-BACS!
Women need to think twice before they put their lives at risk by saying yes to a repeat elective cesarean! This was just forwarded to me from our local ICAN chapter leader about a new VBAC safety study:
Vaginal Birth After Cesarean Found to be Safer for Moms than an Elective Repeat Cesarean
A study appearing in the June edition of the journal Obstetrics andGynecology reviews evidence about maternal and neonatal outcomes relating to vaginal birth after cesarean (VBAC). The study authors identified relevant studies from multiple searches of MEDLINE, DARE and the Cochrane data bases(1980 to September 2009) and from recent systematic reviews, reference lists, editorials, Web sites and experts. Overall, there were low rates of maternal harm for both trial of labor and elective repeat cesarean delivery. Maternal mortality rates were higher for elective repeat cesarean delivery at 0.013% compared with 0.004% for trial of labor. Rates of maternal hysterectomy, hemorrhage and transfusions were similar for both trial of labor and elective repeat cesarean delivery. Perinatal mortality was increased for trial of labor (0.13% compared with 0.05% for elective repeat cesarean delivery. The study authors concluded that VBAC is a reasonable choice for the majority of women, since adverse outcomes were rare.
To access the full study online, go to: http://journals.%20lww.com/greenjou%20rnal/Fulltext/%202010/06000/%20Vaginal_Birth_%20After_Cesarean_%20_New_Insights_%20on.25.aspx
ICAN of SLO: icanslo@yahoo.com
Vaginal Birth After Cesarean Found to be Safer for Moms than an Elective Repeat Cesarean
A study appearing in the June edition of the journal Obstetrics andGynecology reviews evidence about maternal and neonatal outcomes relating to vaginal birth after cesarean (VBAC). The study authors identified relevant studies from multiple searches of MEDLINE, DARE and the Cochrane data bases(1980 to September 2009) and from recent systematic reviews, reference lists, editorials, Web sites and experts. Overall, there were low rates of maternal harm for both trial of labor and elective repeat cesarean delivery. Maternal mortality rates were higher for elective repeat cesarean delivery at 0.013% compared with 0.004% for trial of labor. Rates of maternal hysterectomy, hemorrhage and transfusions were similar for both trial of labor and elective repeat cesarean delivery. Perinatal mortality was increased for trial of labor (0.13% compared with 0.05% for elective repeat cesarean delivery. The study authors concluded that VBAC is a reasonable choice for the majority of women, since adverse outcomes were rare.
To access the full study online, go to: http://journals.%20lww.com/greenjou%20rnal/Fulltext/%202010/06000/%20Vaginal_Birth_%20After_Cesarean_%20_New_Insights_%20on.25.aspx
ICAN of SLO: icanslo@yahoo.com
Sunday, May 30, 2010
Inspiration & Wisdom for Labor, Birth & Parenting
"Of course there is no formula for success except perhaps an unconditional acceptance of life and what it brings." Arthur RubinsteinVideo : "Reflections of Motherhood"
One to inspire women planning to V-BAC: "You are building new pathways in your brain now, preparing a home for the you who is emerging. The new you isn't the arrival of someone other than you; she's the emergence of whom you've always been but have long kept hidden. Your need is not to replace some defective self, but to invoke into operation once more the perfect you that is the truth of who you are." Marianne Williamson"My grandmother commented that babies don't read books. Really all I needed to do was "read" my baby." Claire Niala
Video: Maya Angelou recites her poem, "Still I Rise"
Video: "You Can Do Anything"
Tuesday, May 11, 2010
A Letter to Baby Jalilah
Dear Jalilah,
I hope you will come to know your mother as I know her. I wish you could have seen how hard she worked, how much she cared and how difficult her path. She is a powerful woman who will perservere and survive against incredible odds. I know she has so much to give you. Now that the first difficult weeks of colic and latch on and lack of sleep and healing are fading the blessings of motherhood can flourish and grow. Love her little Jalilah all of her days because I know she loves you with all of her heart.
Adrift on the Ocean of American Democracy
Last summer I embarked on my maiden voyage into the turbulent waters of the democratic process. I had been contacted by the Mama Campaign, a grassroots organization trying to make history. They were lobbying for a woman's right to birth either in a hospital, birth center, or at home; with a doctor, certified nurse midwife or a professional midwife. They were pushing to include equal payment for all of these options into the health care legislation. To accomplish their goal they had launched a national effort to have women contact their local representatives and speak to them about the importance of women having birth choices.
As a doula and childbirth educator I have been working one-on-one with women for many years supporting them in their birth choices. On a community level I had helped found the Birth & Baby Resource Network to help inform women about their choices locally. But I never considered any of this as being involved in politics. It was just my way of helping the women I knew have the births that they wanted. Here was a chance to do something locally and perhaps have an impact nationally.
Intrigued but uncertain I went to the women of the Birth & Baby Resource Network and said, "I'd like to do something about this. What do you think? Is this something we want to stand up for? Will I have your backing if I lead a delegation to speak to Lois Capps?" All the women immediately encouraged and supported me.
Buoyed by their enthusiasm I reached into our birth community for shipmates in my endeavor. Not surprisingly I was immediately joined by retired certified nurse midwife Linda Seeley; Edana Hall, licensed midwife; Laurie Stern a registered nurse certified in neonatal nursing; and Megan Bochum, former International Cesarean Awareness Network leader. These women have been working with and for birthing women and their families in our community for many years. They have a passion for women's birth rights.
We discussed and refined our goal, set a timeline and divided the work. Researching that day we suddenly realized that Representative Capps was on the congressional committee working on the health legislation. For the first time it occurred to us that we might actually be able to do something that mattered.
Along the way more women came on board. My intrepid crew of professionals and community leaders also included: Miday Belden-Johnson, CNM; Stephanie Wilson, SLO-Child Abuse Prevention Council specialist; Jessica Elliott, BBRN President; and Janet Murphy, Cal Poly Child Development Specialist. Each one did research that was added to our presentation packet covering issues on safety, the licensing process, the potential financial impact, the importance of bonding, cesarean prevention and postpartum depression prevention.
We reached out to mothers in our community. Many of these busy women took the time to stop and write a letter about how their birth with a midwife affected their lives. Reading their poignant letters reminded me of why I first began championing midwifery and out-of-hospital birth and gave me fresh incentive to keep forging ahead on the project.
San Luis native Sandy Rodriguez, CNM kindly allowed me to use her as an example of how just one midwife can make a difference. She has caught babies in our hospitals for 27 years now. I calculated how much money she had saved our community over the years and came up with a staggering $12.3 to $24.7 million dollars saved and 300 to 600 women spared from undergoing major abdominal surgery as part of their birth process.
In June it was time to join our small craft with the Democratic Party’s Armada so we sat down with Betsy Umhofer from Rep. Capps’ office to float our ideas for the health care bill. She listened with respect and interest as our panel somewhat nervously presented our information. It felt good to make our case and have someone really listen. Ms. Umhofer explained that Congresswoman Capps was interested in what we had to say and had a staff member in D.C. who was currently working on women’s health issues. She graciously accepted our packet and said she would pass it along to her counterpart in Washington.
So now we were tied to Lois Capps’ ship; to come sailing in with flying colors or sink into the murky depths never to be heard from again. I felt very heroic sailing out within that shining Armada to battle upon the high sea. As the summer wore on into the fall I became increasingly depressed watching our fleet going round and round caught in a whirlpool of bitter political rhetoric. In the winter I began to despair that the whole adventure would be for naught seeing the whole country stalled in the doldrums of ridiculous political posturing. In February I was feeling downright mutinous. Would we be forever adrift on this never ending sea of compromise? And then March 22 came and I received an e-mail from the Mama Campaign. We did it!
On the day President Obama signed the health care bill he made history for women across America; women who want to birth with midwives in freestanding birth centers; women who want to birth with people who believe in and respect the innate power of women to bring their babies into this world safely and peacefully. And I felt like Jason triumphantly sailing into port clutching the Golden Fleece.
True it isn’t the whole Fleece; midwives who help women give birth in the privacy of their own homes will still not be covered by Medicaid, but it is an historic start with the potential to lead birth in a whole new direction in this country. It is after all only a baby step but as mothers we understand just how far baby steps can lead.
As a doula and childbirth educator I have been working one-on-one with women for many years supporting them in their birth choices. On a community level I had helped found the Birth & Baby Resource Network to help inform women about their choices locally. But I never considered any of this as being involved in politics. It was just my way of helping the women I knew have the births that they wanted. Here was a chance to do something locally and perhaps have an impact nationally.
Intrigued but uncertain I went to the women of the Birth & Baby Resource Network and said, "I'd like to do something about this. What do you think? Is this something we want to stand up for? Will I have your backing if I lead a delegation to speak to Lois Capps?" All the women immediately encouraged and supported me.
Buoyed by their enthusiasm I reached into our birth community for shipmates in my endeavor. Not surprisingly I was immediately joined by retired certified nurse midwife Linda Seeley; Edana Hall, licensed midwife; Laurie Stern a registered nurse certified in neonatal nursing; and Megan Bochum, former International Cesarean Awareness Network leader. These women have been working with and for birthing women and their families in our community for many years. They have a passion for women's birth rights.
We discussed and refined our goal, set a timeline and divided the work. Researching that day we suddenly realized that Representative Capps was on the congressional committee working on the health legislation. For the first time it occurred to us that we might actually be able to do something that mattered.
Along the way more women came on board. My intrepid crew of professionals and community leaders also included: Miday Belden-Johnson, CNM; Stephanie Wilson, SLO-Child Abuse Prevention Council specialist; Jessica Elliott, BBRN President; and Janet Murphy, Cal Poly Child Development Specialist. Each one did research that was added to our presentation packet covering issues on safety, the licensing process, the potential financial impact, the importance of bonding, cesarean prevention and postpartum depression prevention.
We reached out to mothers in our community. Many of these busy women took the time to stop and write a letter about how their birth with a midwife affected their lives. Reading their poignant letters reminded me of why I first began championing midwifery and out-of-hospital birth and gave me fresh incentive to keep forging ahead on the project.
San Luis native Sandy Rodriguez, CNM kindly allowed me to use her as an example of how just one midwife can make a difference. She has caught babies in our hospitals for 27 years now. I calculated how much money she had saved our community over the years and came up with a staggering $12.3 to $24.7 million dollars saved and 300 to 600 women spared from undergoing major abdominal surgery as part of their birth process.
In June it was time to join our small craft with the Democratic Party’s Armada so we sat down with Betsy Umhofer from Rep. Capps’ office to float our ideas for the health care bill. She listened with respect and interest as our panel somewhat nervously presented our information. It felt good to make our case and have someone really listen. Ms. Umhofer explained that Congresswoman Capps was interested in what we had to say and had a staff member in D.C. who was currently working on women’s health issues. She graciously accepted our packet and said she would pass it along to her counterpart in Washington.
So now we were tied to Lois Capps’ ship; to come sailing in with flying colors or sink into the murky depths never to be heard from again. I felt very heroic sailing out within that shining Armada to battle upon the high sea. As the summer wore on into the fall I became increasingly depressed watching our fleet going round and round caught in a whirlpool of bitter political rhetoric. In the winter I began to despair that the whole adventure would be for naught seeing the whole country stalled in the doldrums of ridiculous political posturing. In February I was feeling downright mutinous. Would we be forever adrift on this never ending sea of compromise? And then March 22 came and I received an e-mail from the Mama Campaign. We did it!
On the day President Obama signed the health care bill he made history for women across America; women who want to birth with midwives in freestanding birth centers; women who want to birth with people who believe in and respect the innate power of women to bring their babies into this world safely and peacefully. And I felt like Jason triumphantly sailing into port clutching the Golden Fleece.
True it isn’t the whole Fleece; midwives who help women give birth in the privacy of their own homes will still not be covered by Medicaid, but it is an historic start with the potential to lead birth in a whole new direction in this country. It is after all only a baby step but as mothers we understand just how far baby steps can lead.
Wednesday, May 5, 2010
Welcome Annika!
Congratulations to Tiffany and Jeorn!
The road of life is never smooth and straight but it is the ups and downs, twists and turns that help us grow.
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